Nasal saline irrigations for the symptoms of chronic rhinosinusitis

  • Review
  • Intervention

Authors


Abstract

Background

The use of nasal irrigation for the treatment of nose and sinus complaints has its foundations in yogic and homeopathic traditions. There has been increasing use of saline irrigation, douches, sprays and rinsing as an adjunct to the medical management of chronic rhinosinusitis. Treatment strategies often include the use of topical saline from once to more than four times a day. Considerable patient effort is often involved. Any additional benefit has been difficult to discern from other treatments.

Objectives

To evaluate the effectiveness and safety of topical saline in the management of chronic rhinosinusitis.

Search methods

Our search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4 2006), MEDLINE (1950 to 2006) and EMBASE (1974 to 2006). The date of the last search was November 2006.

Selection criteria

Randomised controlled trials in which saline was evaluated in comparison with either no treatment, a placebo, as an adjunct to other treatments or against treatments. The comparison of hypertonic versus isotonic solutions was also compared.

Data collection and analysis

Trials were graded for methodological quality using the Cochrane approach (modification of Chalmers 1990). Only symptom scores from saline versus no treatment and symptom and radiological scores from the hypertonic versus isotonic group could be pooled for statistical analysis. A narrative overview of the remaining results is presented.

Main results

Eight trials were identified that satisfied the inclusion criteria. Three studies compared topical saline against no treatment, one against placebo, one as an adjunct to and one against an intranasal steroid spray. Two studies compared different hypertonic solutions against isotonic saline.

There is evidence that saline is beneficial in the treatment of the symptoms of chronic rhinosinusitis when used as the sole modality of treatment. Evidence also exists in favour of saline as a treatment adjunct. No superiority was seen when saline was compared against a reflexology 'placebo'. Saline is not as effective as an intranasal steroid. Some evidence suggests that hypertonic solutions improve objective measures but the impact on symptoms is less clear.

Authors' conclusions

Saline irrigations are well tolerated. Although minor side effects are common, the beneficial effect of saline appears to outweigh these drawbacks for the majority of patients. The use of topical saline could be included as a treatment adjunct for the symptoms of chronic rhinosinusitis.

摘要

背景

利用鼻內鹽水沖洗來改善慢性鼻竇炎症狀

利用鼻內沖洗來治療鼻腔及鼻竇的不適是根據在傳統瑜珈相關及順勢(homeopathic)醫療的基礎上。越來越多人用鹽水來沖洗,灌洗,噴灑,及潤濕後吞下等方式來輔助慢性鼻竇炎的內科治療。治療方式通常用局部鹽水從每天1次到超過4次的沖洗,常需要病人非常盡力配合,其任何附加利益很難與其他治療區分

目標

評估局部鹽水用在慢性鼻竇炎的效果及安全性

搜尋策略

搜尋包括the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4 2006), MEDLINE (1950 to 2006)及EMBASE (1974 to 2006)。最後搜尋日期為2006年11月

選擇標準

評估比較鹽水與無治療或安慰劑、把其當成輔助療法或作為主要治療的隨機對照研究,也比較高張溶液與等張溶液的不同

資料收集與分析

利用Cochrane方式(modification of Chalmers 1990)把試驗的設計方法分品質等級。只收集到鹽水對無治療的症狀分數、及高張溶液對等張溶液的症狀和影像學分數資料來做統計學分析,其餘結果用敘述性概要方式提出

主要結論

找到8個試驗符合收集標準。3個研究比較局部鹽水對無治療,1個比較鹽水對安慰劑,1個研究併用鹽水與鼻內類固醇噴劑,1個比較鹽水對鼻內類固醇噴劑,2個研究比較不同的高張溶液對等張溶液。證據顯示當鹽水單獨用來治療慢性鼻竇炎,對症狀是有幫助的,證據也顯示用鹽水來輔助傳統治療有較好的結果。但當鹽水與安慰劑“反射療法”相比時,卻沒有較好的結果。鹽水還是沒有比鼻內類固醇有效。有些證據指出高張溶液改善客觀的評分分數,但對症狀的影響程度較不清楚

作者結論

鹽水沖洗是很容易被適應的方法。雖然有些常見的輕微副作用,但對大多數病患來說,鹽水沖洗所帶來的幫助效果超過這些缺點。局部鹽水可被作為慢性鼻竇炎症狀的輔助治療之ㄧ

翻譯人

本摘要由國泰綜合醫院方德詠翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

利用鼻內鹽水沖洗來治療慢性鼻竇炎症狀:利用鼻內沖洗來治療鼻腔及鼻竇的不適是根據在傳統瑜珈相關及順勢(homeopathic)醫療的基礎上。它通常處方在用來輔助其他治療,例如鼻內類固醇及抗生素,然而在準備及給予這些溶液時需要病人盡力配合。這篇回顧總結了鹽水沖洗用在慢性鼻竇炎症狀的效果,證據顯示它可減輕症狀、幫忙輔助傳統治療,且可被大多數病患適應。雖然沒有證據顯示它可代替標準治療,但對於持續有鼻部疾病的病患來說,增加局部鼻內鹽水沖洗非常可能可改善症狀的控制。至於不同的特殊溶液、劑量、或給予路徑,沒有關於這方面的建議。試驗中沒有明顯的副作用被報告

Plain language summary

Nasal irrigation with saline (salt water) for the symptoms of chronic rhinosinusitis

The use of nasal irrigation for the treatment of nose and sinus complaints has its foundations in yogic and homeopathic traditions. It is often prescribed as an adjunct to other treatments such as intranasal steroids or antibiotics. However, there is significant effort involved in preparing and delivering the solutions. This review summarises the evidence for the effect of saline irrigations in the management of the symptoms of chronic rhinosinusitis. There is evidence that they relieve symptoms, help as an adjunct to treatment and are well tolerated by the majority of patients. While there is no evidence that saline is a replacement for standard therapies, the addition of topical nasal saline is likely to improve symptom control in patients with persistent sino-nasal disease. No recommendations can be made regarding specific solutions, dosage or delivery. There are no significant side-effects reported in trials.

Ancillary